Quiz 1 (Mike).txt

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What is Parturition?

Parturition is the process of giving birth and consists of

Rupture of the membranes

Dilation of the cervix

Contraction of the uterus

Separation of the placenta

Shrinking of the uterus

How many stages of labor are there?

4, but 3 main that we worry about, and labor is actually one continuous event

What is stage 1 of labor and delivery?

Onset of regular contractions to complete dilatation of the cervix.

How long will stage 1 usually last?

7-18 hours

What factors influence the duration of ALL stages?

Multigravida vs. Primigravida

Sedation

Stress

What is stage 2 of labor and delivery?

Full dilatation and effacement of the cervix to delivery of the fetus

Dilatation is the widening of the cervical opening. A 10 cm diameter cervical opening is considered fully dilated.

Effacement is the stretching and thinning of the cervix. 100% effacement is when the cervix is not distinguishable from the uterus

How long does stage 2 of labor and delivery last?

20 min to 1-2 hours

What is stage 3 of labor and delivery?

Delivery of the fetus to delivery of the placenta

The fetus is in the head down position is the most common presentation. (Vertex position)

There is also a fourth stage (not considered a major stage) where the uterus begins to shrink back to normal

How long does stage 3 of labor and delivery last?

Lasts 3-4 minutes up to 45 minutes

What is the most common process and presentation of the fetus?

As the fetus begins down the birth canal, the head turns to a face down position for passage through the pelvis.

Upon delivery of the head, the fetus rotates internally to ease passage of the shoulders through the pelvis.

The upper shoulder delivers first, followed by the lower shoulder.

After delivery of the shoulders, the rest of the body exits rather quickly.

The umbilical cord is clamped and the baby begins life outside the uterus

What is Tocolysis?

the process of stopping labor (drug induced)

What are the different types of Pharmacologic Tocolysis?

Beta adrenergics (terbutaline sulfate or ritodrine).

- Relaxation of smooth muscle in the uterus

Magnesium sulfate to decrease muscle contractility

Indomethacin to inhibit prostoglandin synthesis.

- Softens the cervix making it more susceptible to contraction

Calcium channel blockers like nifedipine.

- The uterus is a large muscle made up of thousands of muscle cells. When calcium enters these cells, the muscle contracts and tightens. When calcium flows back out of the cell, the muscle relaxes. Calcium channel blockers work by preventing calcium from moving into the muscle cells of the uterus, making it less able to contract.

What are the different types of Non-Pharmacologic Tocolysis?

Comprehensive accessible family planning.

Risk assessment and counseling before conception.

Risk assessment for prenatal patients.

Patient education to identify signs of premature labor and when to seek help.

What is Dystocia?

prolonged and difficult labor

What are common causes of Dystocia?

Dysfunction of the uterus.

Cephalopelvic disproportion.

Abnormal presentation.

Hydrocephalus.

Abnormality in size or shape of birth canal.

Excessive fetal size.

What is the Breech presentation?

The most common of all abnormal presentations (3-5% of all births).

Three varieties:

- Complete breech. Feet , legs, and buttocks present together.

- Incomplete or footling breech. One or both feet descend into the birth canal first.

- Frank breech. The legs are flexed against the body with the feet near the face with the buttocks being the presenting part.

What is Face Presentation?

Abnormal fetal presentation: The head enters the birth canal so the sutures cannot override each other and the head must pass at its full size

What is Transverse lie?

Abnormal fetal presentation: The fetus is positioned perpendicular to the birth canal with the back or back shoulders being presented

What is Prolapse of umbilical cord?

Abnormal fetal presentation: Prolapse is when the umbilical cord passes through the birth canal ahead of a body part crimping the cord

What is Occult compression?

Abnormal fetal presentation: When the cord is compressed between the fetus and the wall of the birth canal

What is Nuchal cord

Abnormal fetal presentation: Where the umbilical cord wraps around the fetus's neck

What can go wrong with transition from intrauterine life to extrauterine life?

Lack of ventilation of the newborn�s lungs results in sustained constriction of the pulmonary arterioles, preventing systemic arterial blood from being oxygenated

Prolonged lack of adequate perfusion and oxygenation to the baby�s organs can lead to brain damage, damage to other organs, or death

What are signs of a compromised newborn?

Poor muscle tone

Depressed respiratory drive

Bradycardia

Low blood pressure

Tachypnea

Cyanosis

Why and how does prematurity affect the need for resuscitation?

Possible surfactant deficiency

Decreased drive to breathe

Rapid heat loss, poor temperature control

Possible infection

Susceptible to brain hemorrhage

Susceptible to hypovolemia secondary to blood loss

Weak muscles make spontaneous breathing difficult

Immature tissues may be damaged by excessive oxygen

Define and describe primary vs. secondary apnea and how to treat each.

Primary Apnea: When a fetus/newborn FIRST becomes deprived of oxygen (Asphyxia), an initial period of attempted rapid breathing is followed by primary apnea and dropping heart rate that will improve with tactile stimulation